Application for NB Productions
Please circle the class and the location you
are interested in.
Puppy Kindergarten for puppies from 8 to 21 weeks, Beginner Level,
Introduction to Rally Obedience, Intermediate Level Fee:
$85.00 The Civilized Canine (CGC) Fee:
Greenfield, MA, Turners Falls, MA, Wendell MA, Brattleboro,
Make Checks Payable to Laurie LaValley
Round Hill Road
Haydenville, MA 01039
Trainer’s Name: ____________________________________________________
______________ State: _____ Zip:
Breed of Dog: _________________ Age:
_____ Name: ______________________
Please answer all questions.
Are you experiencing any immediate problems?
Yes No What are they?
Has your dog been socialized with people other than
family? Yes No
Has your dog been socialized with other animals? Yes No
Agreement: Please read and sign.
In consideration of the acceptance of this application I (we) agree
to hold this organization and it’s agents, harmless from any
claim for loss or injury which may be alleged to have been caused
directly or indirectly to any person or thing by the act of this dog
while in or upon the premises or grounds or near any entrance thereto,
and I (we) personally assume all responsibility and liability for
any such claim; and I (we) further agree to hold the aforementioned
parties harmless from any claim for loss of this dog by disappearance,
theft, death or otherwise, and from any claim of damage or injury
to the dog, whether such loss, disappearance, theft damage or injury
be caused or alleged to be caused by the negligence of the organization
or any of the parties aforementioned, or by the negligence of any
other person, or any other cause of causes.
Signature of owner or his/her agent duly authorized
to make this application:
For Office Use Only
Date: _____________ Fee Paid:
__________ Cash: ____ Check Number:
Medical Information OK? ________
Received By: _________________